What is a HEENT exam?
The acronym HEENT stands for Head, Eyes, Ears, Nose, and Throat. A HEENT exam is a non-invasive physical assessment that healthcare providers, such as doctors, nurse practitioners, and physician assistants, perform as part of a routine or targeted physical examination [1]. The exam focuses on a specific region of the body, allowing for a concentrated assessment to diagnose or rule out conditions affecting these areas. It is particularly useful for evaluating symptoms like headaches, sinus pressure, vision changes, hearing issues, sore throats, and neck pain [1].
The exam is systematic, meaning the provider follows a specific, repeatable order to ensure no aspect is missed. It combines several diagnostic techniques:
- Inspection: Visually examining the physical characteristics of each area [1].
- Palpation: Using touch to feel for masses, tenderness, or unusual textures [1].
- Auscultation: Listening for sounds, although less common in this specific exam area.
While the name explicitly mentions the five areas, the examination often extends to include the neck and associated structures, such as the lymph nodes and thyroid gland, due to their proximity and interconnectedness with the other systems [1].
Head and neck examination
The evaluation of the head and neck is the starting point of the HEENT exam. It involves both visual inspection and tactile palpation [1].
Examination of the head
During the head exam, the provider assesses several aspects, including the scalp for lesions, hair loss, or parasites; the skull for masses or tenderness; and the face for symmetry, movements, or swelling [1].
Examination of the neck
An assessment of the neck is vital as it houses the thyroid and numerous lymph nodes. The provider checks for symmetry, palpates the thyroid gland while the patient swallows to detect nodules or enlargement, and examines various lymph node chains for swelling or tenderness, which can indicate infection or other issues [1].
Eye examination
The eyes provide a wealth of information about a patient's overall health. A provider will conduct several checks using a penlight and, sometimes, an ophthalmoscope [1].
Common visual tests
- Visual acuity: A quick check of vision [1].
- External structures: Inspecting eyelids, eyelashes, and conjunctiva for swelling, redness, or discharge [1].
- Sclera: Checking the white part of the eye for discoloration like jaundice [1].
Pupil assessment
- PERRLA: An acronym for Pupils Equal, Round, and Reactive to Light and Accommodation, assessing pupil function [1].
- Extraocular movements (EOMs): Checking eye movement in six cardinal positions [1].
Ear and nose examination
These interconnected passages are often affected by the same conditions, such as allergies and upper respiratory infections [1].
Ear examination
Using an otoscope, the provider inspects the outer ear, ear canal for discharge or foreign bodies, and the tympanic membrane (eardrum) for signs of infection like redness or bulging [1].
Nose and sinus examination
- Inspection: Checking the external nose and internal nasal mucosa for color, moisture, discharge, or polyps [1].
- Septum: Checking if the nasal septum is midline [1].
- Sinus palpation: Applying pressure to the frontal and maxillary sinuses to check for tenderness indicative of a sinus infection [1].
Throat and mouth examination
The final part of the HEENT exam is an inspection of the mouth and throat, offering valuable clues about the patient's health [1].
Oral cavity assessment
Using a light and a tongue depressor, the provider examines the lips, gums, oral mucosa, teeth, and tongue for sores, swelling, color, or moisture [1].
Pharynx and tonsils
- The patient says "ahh" to allow inspection of the posterior pharynx and tonsils for swelling, redness, or exudates [1].
- The uvula is checked for midline position [1].
Normal vs. Abnormal Findings Comparison
Understanding the contrast between typical and atypical findings helps both patient and provider contextualize the results of the exam. This table summarizes key differences [1].
| Area | Normal Findings | Abnormal Findings |
|---|---|---|
| Head | Normocephalic (normal size/shape), scalp intact, no masses. | Tenderness, deformities, masses, unusual hair loss. |
| Eyes | PERRLA, EOMs intact, conjunctiva clear, sclera white. | Unequal pupils, poor reaction to light, nystagmus (uncontrolled eye movement), discharge, yellow sclera (jaundice). |
| Ears | Pinna non-tender, canals clear, tympanic membranes pearly gray. | Tenderness (otitis externa), discharge, fluid behind eardrum (otitis media), redness, bulging. |
| Nose | Mucosa pink & moist, septum midline, no discharge. | Pale or swollen mucosa (allergic rhinitis), deviated septum, persistent discharge. |
| Throat | Pink pharynx, tonsils without exudates, uvula midline. | Redness (pharyngitis), tonsillar exudates (strep), swelling, visible sores. |
| Neck | Supple, trachea midline, non-palpable lymph nodes. | Stiff neck, tracheal deviation, palpable/tender lymph nodes, thyroid masses. |
Documenting the HEENT exam
Proper documentation is critical for creating an accurate patient record and ensuring continuity of care. Normal findings are often documented concisely using standardized medical abbreviations, while abnormal findings are described in detail [1].
For more information on proper medical examination techniques, authoritative resources such as Bates' Guide to Physical Examination and History Taking offer comprehensive instruction.
Conclusion
Describing a HEENT exam involves detailing the systematic inspection and palpation of the head, eyes, ears, nose, and throat. This essential part of a physical assessment provides healthcare providers with a thorough overview of these interconnected body systems. From assessing pupils and eardrums to palpating lymph nodes and the thyroid gland, the HEENT exam is a fundamental tool for diagnosing a wide array of conditions and ensuring overall health monitoring. Understanding what is involved can help patients feel more at ease and informed during their medical visits.
